			<table width="700" height="215" border="0" align="center" cellpadding="1" cellspacing="1" style="background-color: white; font-family: sans-serif;">
				<tr>
					<td align="center" valign="top">
						<table width="700" border="0" align="center" cellpadding="4" cellspacing="0" style="margin: 5px 5px 5px 5px; background-color: #adeae9; font-size: 22px;">
							<tr>
								<td colspan="2" align="center" valign="middle"><font size="5"><b>ยืนยันทำรายการ Pre-auth</b></font></td>
							</tr>
							<tr height="20">
								<td width="250" bgcolor="#adeae9" align="right">Policy No : </td>
								<td width="450" bgcolor="#adeae9" align="left"><span style="color: red;">{$data.policy_no}</span></td>
							</tr>
							<tr height="20">
								<td bgcolor="#adeae9" align="right">Card No : </td>
								<td bgcolor="#adeae9" align="left"><span style="color: red;">{$data.card_no}</span></td>
							</tr>
							<tr height="20">
								<td bgcolor="#adeae9" align="right">ชื่อ ผอป. : </td>
								<td bgcolor="#adeae9" align="left">{$data.member_name} {$data.member_lname}</td>
							</tr>
							<tr height="20">
								<td bgcolor="#adeae9" align="right">บัตรประชาชน : </td>
								<td bgcolor="#adeae9" align="left">{$data.nat_id}</td>
							</tr>
							<tr>
								<td colspan="2" align="center" valign="middle">
									<input type="hidden" name="preauth_id" id="preauth_id" value="{$data.preauth_id}">
									<input type="hidden" name="user_id" id="user_id" value="{$_profile->userid}">
									<input type="hidden" name="policy_no" id="policy_no" value="{$data.policy_no}">
									<input type="hidden" name="policy_id" id="policy_id" value="{$data.policy_id}">
									<input type="hidden" name="preauth_datetime" id="preauth_datetime" value="{$data.today}">
									<input type="hidden" name="customer_type_desc" id="customer_type_desc" value="{$data.customer_type_desc}">
									
									<input type="submit" name="btn_confirm" id="btn_confirm" value="ยืนยัน" style="width:150px; height:40px;" onclick="_renderInsertPreauth();">
									<a id="link_preauth_fund"></a>
									&nbsp;&nbsp;
									<input type="button" name="btn_cancel" id="btn_cancel" value="ยกเลิก" style="width:150px; height:40px;" onClick="closeLightBox('link_preauth_fund','fancybox-ajax-light');">								
								</td>
							</tr>
						</table>
					</td>
				</tr>
			</table>